|
Allergies |
mh_allergies |
N |
radio |
1, Yes | 0, No | 9, Unknown |
- |
- |
|
Age of onset |
mh_al_age |
N |
text |
- |
- |
- |
|
Additional Details: if yes for the above condition |
mh_al_details |
Y |
text |
- |
- |
- |
|
Alzheimer Disease |
mh_alz |
N |
radio |
1, Yes | 0, No | 9, Unknown |
- |
- |
|
Age of onset |
mh_alz_age |
N |
text |
- |
- |
- |
|
Additional Details: if yes for the above condition |
details_if_yes_for_th2_0f7 |
Y |
text |
- |
- |
- |
|
Anemia/Low Blood |
mh_ane |
N |
radio |
1, Yes | 0, No | 9, Unknown |
- |
- |
|
Age of onset |
mh_ane_age |
N |
text |
- |
- |
- |
|
Additional Details: if yes for the above condition |
mh_ane_details |
Y |
text |
- |
- |
- |
|
Arthiritis |
mh_art |
N |
radio |
1, Yes | 0, No | 9, Unknown |
- |
- |
|
Age of onset |
mh_art_age |
N |
text |
- |
- |
- |
|
Additional Details: if yes for the above condition |
mh_art_details |
Y |
text |
- |
- |
- |
|
Asthma |
mh_ast |
N |
radio |
1, Yes | 0, No | 9, Unknown |
- |
- |
|
Age of onset |
mh_ast_age |
N |
text |
- |
- |
- |
|
Additional Details: if yes for the above condition |
mh_ast_details |
Y |
text |
- |
- |
- |
|
Cancer/Malignancy |
mh_can |
N |
radio |
1, Yes | 0, No | 9, Unknown |
- |
- |
|
Age of onset |
mh_can_age |
N |
text |
- |
- |
- |
|
Additional Details: if yes for the above condition |
mh_can_details |
Y |
text |
- |
- |
- |
|
Chronic bronchitis |
mh_bro |
N |
radio |
1, Yes | 0, No | 9, Unknown |
- |
- |
|
Age of onset |
age_if_yes_for_the_ab2_c5b |
N |
text |
- |
- |
- |
|
Additional Details: if yes for the above condition |
details_if_yes_for_th2_ef2 |
Y |
text |
- |
- |
- |
|
Congestive heart |
mg_conh |
N |
radio |
1, Yes | 0, No | 9, Unknown |
- |
- |
|
Age of onset |
mh_conh_age |
N |
text |
- |
- |
- |
|
Additional Details: if yes for the above condition |
mh_conh_details |
Y |
text |
- |
- |
- |
|
Diabetes |
mh_dia |
N |
radio |
1, Yes | 0, No | 9, Unknown |
- |
- |
|
Age of onset |
mh_dia_age |
N |
text |
- |
- |
- |
|
Additional Details: if yes for the above condition |
mh_dia_details |
Y |
text |
- |
- |
- |
|
Emphysema |
mh_emp |
N |
radio |
1, Yes | 0, No | 9, Unknown |
- |
- |
|
Age of onset |
mh_emp_age |
N |
text |
- |
- |
- |
|
Additional Details: if yes for the above condition |
mh_emp_details |
Y |
text |
- |
- |
- |
|
Epilepsy/Seizures/Convulsions |
mh_epi |
N |
radio |
1, Yes | 0, No | 9, Unknown |
- |
- |
|
Age of onset |
mh_epi_age |
N |
text |
- |
- |
- |
|
Additional Details: if yes for the above condition |
mh_epi_details |
Y |
text |
- |
- |
- |
|
Goitre/Thyroid Disease |
mh_goi |
N |
radio |
1, Yes | 0, No | 9, Unknown |
- |
- |
|
Age of onset |
mh_goi_age |
N |
text |
- |
- |
- |
|
Additional Details: if yes for the above condition |
mh_goi_details |
Y |
text |
- |
- |
- |
|
Head injury |
mh_head |
N |
radio |
1, Yes | 0, No | 9, Unknown |
- |
- |
|
Age of onset |
mh_head_age |
N |
text |
- |
- |
- |
|
Additional Details: if yes for the above condition |
mh_head_details |
Y |
text |
- |
- |
- |
|
Heart attack/angina |
mh_hatt |
N |
radio |
1, Yes | 0, No | 9, Unknown |
- |
- |
|
Age of onset |
mh_hatt_age |
N |
text |
- |
- |
- |
|
Additional Details: if yes for the above condition |
mh_hatt_details |
Y |
text |
- |
- |
- |
|
High blood pressure |
mh_hbp |
N |
radio |
1, Yes | 0, No | 9, Unknown |
- |
- |
|
Age of onset |
mh_hbp_age |
N |
text |
- |
- |
- |
|
Additional Details: if yes for the above condition |
mh_hbp_details |
Y |
text |
- |
- |
- |
|
Liver condition |
mh_lc |
N |
radio |
1, Yes | 0, No | 9, Unknown |
- |
- |
|
Age of onset |
mh_lc_age |
N |
text |
- |
- |
- |
|
Additional Details: if yes for the above condition |
mh_lc_details |
Y |
text |
- |
- |
- |
|
Migrane headaches |
mh_mig |
N |
radio |
1, Yes | 0, No | 9, Unknown |
- |
- |
|
Age of onset |
mh_mig_age |
N |
text |
- |
- |
- |
|
Additional Details: if yes for the above condition |
mh_mig_details |
Y |
text |
- |
- |
- |
|
Osteoporosis/ brittle bones |
mh_ost |
N |
radio |
1, Yes | 0, No | 9, Unknown |
- |
- |
|
Age of onset |
mh_ost_age |
N |
text |
- |
- |
- |
|
Additional Details: if yes for the above condition |
mh_ost_details |
Y |
text |
- |
- |
- |
|
Overweight |
mh_ove |
N |
radio |
1, Yes | 0, No | 9, Unknown |
- |
- |
|
Most you've ever weighed |
mh_weight_highest |
N |
text |
- |
in pounds |
- |
|
In females who were pregnant currently or before: Most you've ever weighed |
mh_weight_fem_preg |
N |
text |
- |
- |
- |
|
Has a doctor been concerned about your weight ? |
dg_overweight_notes |
N |
yesno |
- |
- |
- |
|
Age of onset |
mh_ove_age |
N |
text |
- |
- |
- |
|
Additional Details: if yes for the above condition |
mh_ove_details |
Y |
text |
- |
- |
- |
|
Skin Condition |
mh_sc |
N |
radio |
1, Yes | 0, No | 9, Unknown |
- |
- |
|
Age of onset |
mh_sc_age |
N |
text |
- |
- |
- |
|
Additional Details: if yes for the above condition |
mh_sc_details |
Y |
text |
- |
- |
- |
|
Stroke |
mh_st |
N |
radio |
1, Yes | 0, No | 9, Unknown |
- |
- |
|
Age of onset |
mh_st_age |
N |
text |
- |
- |
- |
|
Additional Details: if yes for the above condition |
mh_st_details |
Y |
text |
- |
- |
- |
|
Ulcer |
mh_ulc |
N |
radio |
1, Yes | 0, No | 9, Unknown |
- |
- |
|
Age of onset |
mh_ulc_age |
N |
text |
- |
- |
- |
|
Additional Details: if yes for the above condition |
mh_ulc_details |
Y |
text |
- |
- |
- |
|
Other neurological problems |
mh_neu |
N |
radio |
1, Yes | 0, No | 9, Unknown |
- |
- |
|
Age of onset |
mh_neu_age |
N |
text |
- |
- |
- |
|
Additional Details: if yes for the above condition |
mh_neu_details |
Y |
text |
- |
- |
- |
|
Fibromyalgia |
mh_fib |
N |
radio |
1, Yes | 0, No | 9, Unknown |
- |
- |
|
Age of onset |
mh_fib_age |
N |
text |
- |
- |
- |
|
Additional Details: if yes for the above condition |
mh_fib_details |
Y |
text |
- |
- |
- |
|
__________________________________________________________________________________________
Additonal Details for medical conditions |
mh_section_1_end |
Y |
notes |
- |
- |
- |
|
2. If yes to any: How do(es) this condition(s) affect your daily life? |
mh_quest2 |
N |
descriptive |
- |
- |
- |
|
2a. Frequent Symptoms |
mh_freqsymp |
N |
radio |
1, Yes | 0, No | 9, Unknown |
- |
- |
|
2b. Sees doctor regularly |
mh_docvisits |
N |
radio |
1, Yes | 0, No | 9, Unknown |
- |
- |
|
2c. Hospitalized or takes medication regularly |
mh_medi |
N |
radio |
1, Yes | 0, No | 9, Unknown |
- |
- |
|
2d. Occupational Disability(Able to work at all?) |
mh_occ_dis |
N |
radio |
1, Yes | 0, No | 9, Unknown |
- |
- |
|
Additional Details |
mh_2_additional_details |
Y |
notes |
- |
- |
- |
|
3. Do you have any other medical problem or condition we haven't discussed |
mh_mp_disc |
N |
radio |
1, Yes | 0, No | 9, Unknown |
- |
- |
|
If yes: Specify |
mh_mp_disc_yes |
Y |
text |
- |
- |
- |
|
4a. Height |
mh_height |
N |
text |
- |
inches |
- |
|
4b. Weight |
mh_weight |
N |
text |
- |
lbs |
- |
|
Have you ever had any of the following tests: |
mh_quest5 |
N |
descriptive |
- |
- |
- |
|
5a. EEG/"Brain Wave" tests |
mh_eeg |
N |
radio |
1, Yes | 0, No | 9, Unknown |
- |
- |
|
5a.2. Years of most recent test for EEG/"Brain Wave" test |
mh_eeg_year |
N |
text |
- |
- |
- |
|
5b. Head CAT scan |
mh_cat |
N |
radio |
1, Yes | 0, No | 9, Unknown |
- |
- |
|
5b.2. Years of most recent test for CAT scan test |
mh_cat_year |
N |
text |
- |
- |
- |
|
5c. Head MRI |
mh_mri |
N |
radio |
1, Yes | 0, No | 9, Unknown |
- |
- |
|
5c.2. Years of most recent test for Head MRI test |
mh_mri_year |
N |
text |
- |
- |
- |
|
Notes: |
mh_5_notes |
Y |
notes |
- |
- |
- |
|
6. Are you taking any medications regularly(includes aspirin and oral contraceptives) |
mh_quest6 |
N |
radio |
1, Yes | 0, No | 9, Unknown |
- |
- |
|
6.a. Total count of medications |
mh_medcount |
N |
text |
- |
- |
- |
|
Medication 1 |
mh_md1 |
N |
text |
- |
- |
- |
|
Dosage (Medication 1) per day |
mh_dos1 |
N |
text |
- |
- |
- |
|
Duration of Dosage (Medication 1) |
mh_dos1_weeks |
N |
text |
- |
in weeks |
- |
|
Medication 2 |
mh_md2 |
N |
text |
- |
- |
- |
|
Dosage (Medication 2) per day |
mh_dos2 |
N |
text |
- |
- |
- |
|
Duration of Dosage (Medication 2) |
mh_dos2_weeks |
N |
text |
- |
in weeks |
- |
|
Medication 3 |
mh_md3 |
N |
text |
- |
- |
- |
|
Dosage (Medication 3) per day |
mh_dos3 |
N |
text |
- |
- |
- |
|
Duration of Dosage (Medication 3) |
mh_dos3_weeks |
N |
text |
- |
in weeks |
- |
|
Medication 4 |
mh_md4 |
N |
text |
- |
- |
- |
|
Dosage (Medication 4) per day |
mh_dos4 |
N |
text |
- |
- |
- |
|
Duration of Dosage (Medication 4) |
mh_dos4_weeks |
N |
text |
- |
in weeks |
- |
|
Medication 5 |
mh_md5 |
N |
text |
- |
- |
- |
|
Dosage (Medication 5 ) per day |
mh_dos5 |
N |
text |
- |
- |
- |
|
Duration of Dosage (Medication 5) |
mh_dos5_weeks |
N |
text |
- |
in weeks |
- |
|
Medication 6 |
mh_md6 |
N |
text |
- |
- |
- |
|
Dosage (Medication 6) per day |
mh_dos6 |
N |
text |
- |
- |
- |
|
Duration of Dosage (Medication 6) |
mh_dos6_weeks |
N |
text |
- |
in weeks |
- |
|
7. Was your own birth or early development abnormal in any way
IF NO, SKIP TO Q8. |
mh_birth_dev |
N |
radio |
1, Yes | 0, No | 9, Unknown |
- |
- |
|
7a. Were there any problems with your mother's health while she was pregnant with you? |
mh_mot_prob |
N |
radio |
1, Yes | 0, No | 9, Unknown |
- |
- |
|
If yes: Specify |
mh_motprob_spec |
Y |
notes |
- |
- |
- |
|
7b. Was your development abnormal in any way, for example did you walk or talk later than other children? |
mh_abdev |
N |
radio |
1, Yes | 0, No | 9, Unknown |
- |
- |
|
If yes: Specify |
mh_abdev_spec |
Y |
notes |
- |
- |
- |
|
8. Have you ever been pregnant?
IF NO, SKIP TO Q9 |
mh_preg |
N |
radio |
1, Yes | 0, No | 9, Unknown |
- |
- |
|
8.a. How many times have you been pregnant including miscarriages, abortions and still births? |
mh_8a |
N |
text |
- |
- |
- |
|
8.i. Number of Miscarriages |
mh_mscar |
N |
text |
- |
- |
- |
|
8.ii. Number of Abortions |
mh_abort |
N |
text |
- |
- |
- |
|
8.iii. Number of Still Births |
mh_still |
N |
text |
- |
- |
- |
|
8b. Number of Live Births |
mh_live |
N |
text |
- |
- |
- |
|
8c. Have you ever had any severe emotional problems during pregnancy or within a month of childbirth ? |
mh_preg_emo |
N |
radio |
0, No | 1, Yes - during pregnancy only | 2, Yes - during post natal only | 3, Yes - both during pregnancy and post natal | 9, Unknown |
- |
- |
|
If yes: Specify |
mh_preg_emo_spec |
Y |
text |
- |
- |
- |
|
9. Have you ever noticed regular mood changes in the premenstrual or menstrual period? |
mh_menst |
N |
radio |
1, Yes | 0, No | 9, Unknown |
- |
- |
|
If yes: Specify |
mh_menst_spec |
Y |
text |
- |
- |
- |
|
10. Have you gone through menopause? |
mh_meno |
N |
radio |
1, Yes | 0, No | 9, Unknown |
- |
- |
|
10a. If yes: Have you ever had any severe emotional problems associated with menopause? |
mh_meno2 |
N |
radio |
1, Yes | 0, No | 9, Unknown |
- |
- |
|
If yes: Specify |
mh_meno2_spec |
Y |
text |
- |
- |
- |
|
Notes |
medical_historycsv_notes |
Y |
notes |
- |
Data migrated from Access |
- |